The Use of Tranexamic Acid for Post-tonsillectomy Hemorrhage in Pediatric Patients: A Scoping Review

Objective: Post-tonsillectomy hemorrhage is a highly studied outcome of tonsillectomy with serious consequences. The off-label use of tranexamic acid (TXA) is of growing interest to control post-tonsillectomy hemorrhage but has not been incorporated in management guidelines. Study Design: Scoping review on the use of tranexamic acid for post-tonsillectomy hemorrhage. Setting: N/A. Methods: A comprehensive literature search was performed across the following research databases: PubMed, Embase, CINAHL, and Web of Science. The search was limited to English-language studies and patients without prior diagnosis of bleeding disorders. The articles were screened for relevance based on inclusion and exclusion criteria. Our initial search generated 131 articles. Results: A total of 24 articles were identified, published in mostly otolaryngology journals. Over 96000 tonsillectomy cases were included. There was variability in administration routes: intravenous, nebulized, oral, and topical. Intravenous was most used, particularly as prophylaxis for post-tonsillectomy hemorrhage, and nebulized administration was more common in therapeutic settings. Dosing regimens ranged between 5 and 15 mg/kg. We found mixed results across studies regarding peri-operative and post-operative bleeding outcomes, though multiple studies demonstrated decreased intraoperative bleeding. Many studies concurred that TXA was safe to use for post-tonsillectomy hemorrhage. Conclusion: The existing literature indicates TXA shows promising results in safety and reducing intraoperative blood volume loss. Further prospective and randomized controlled trials are needed to ensure the clinical benefits of TXA in tonsillectomy surgery prior to the inclusion in clinical practice guidelines.